Doctors Without Borders/Médecins San Frontières (MSF) has helped established a network of 30 local psychologists as part of its medical support projects in the city of Misrata, which has been the scene of fierce fighting for more than four months.

In a country that hadn't experienced war for over four decades, there were few psychiatrists. In general, psychology is an often neglected and undervalued aspect of mental health in Libya. MSF therefore focused its psychological activities on helping to build and support a network of local psychologists with access to both patients receiving treatment in the city’s main health facilities, as well members of the community outside the medical system.

“Prior to the war, there were only child psychology services in Misrata for treating conditions such as Down Syndrome or autism, nothing else, and even psychiatry wasn’t really being offered effectively,” said MSF psychologist Elias Abi-Aad. “They had no experience in normal clinical psychology at all, let alone trauma and war-related mental health disorders.”

In addition to providing training in conducting basic therapy and consultations, MSF psychologists shared the psychological treatment tools developed throughout the organization’s 40-year history of intervening in war contexts. “Before I met MSF, my knowledge as a psychologist was very basic,” said local psychologist Fatima Alaylech. “I learnt a lot from their trainings, especially how to deal with post-war trauma because we as Libyans never had this experience before, and I had never treated these kind of patients.”

Members of the network have been provided with guidance in recognizing trauma-related mental health symptoms and establishing clear referral criteria. MSF conducts regular training sessions and meetings to discuss practical issues like how to conduct a consultation, build a relationship with the client, establish a diagnosis, and carry out follow-up treatment. Specialized information on addressing disorders relating to the current situation in Misrata is also covered.

“We discuss everything from the patient’s story, to the disorder they are complaining about, common war-related psychological symptoms, establishing plans of action, and setting objectives that both the patient and psychologist want to reach,” said Abi-Aad.

“Wounded”

Initially, the local community and medical staff were unaccustomed to these sorts of mental health activities. MSF staff took their time to explain the nature of psychological interventions and the need to address issues now to prevent potentially severe consequences in the future.

Little by little, patients with no real previous experience with the medical system began approaching the network for assistance. So did overworked local medical staff that were suffering from stress and anxiety. because of the work they had been doing.

“We presented the war as an external factor causing problems that were unusual and that the general population was not used to,” Abi-Aad said. “This way, it was easier for people to seek help because they could consider themselves ‘wounded’ and not crazy or having something wrong with them.”

As recognition grew of the need for psychological care in the community, the network gradually found its place within the package of care provided to patients in Misrata.

Main Disorders

In addition to referrals from local medical staff, men, women and children are being treated by the network for anxiety, depression, post-traumatic reactions, psychosomatic complaints, and behavioral disorders caused by factors such as loss of family members and friends, the constant bombardment of the city, displacement, significant physical injuries and handicaps, and fear for the future.

“In the last few months, people have started to show psychosomatic symptoms even if they were not injured physically by the war,” said Alaylech. “Those sort of symptoms normally appear five-to-six months after the traumatic experience, but we are already starting to see more and more of these sorts of disorders, such as depression, anxiety, and various neuroses in children, such as bedwetting and aggressive and violent behavior.”

The network’s psychologists are in close contact with Misrata’s pediatric wards and provide information to local pediatricians about identifying mental health issues.

“I once met a mother, who heard me talking to the pediatrician about referral criteria for children, and she came to me and said ‘I think my kid fits some of those criteria,’” Abi-Aad said. “Her child was suffering from acute stomach pain that the doctor could find no physical cause for. We treated the child and it turned out to be psycho-somatic related. He’s doing better now and the pain is gone.”

Sustainability

Since becoming fully established at the beginning of June, the network has treated around 200 patients. MSF plans to continue the program to consolidate psychological services in Misrata’s health system and expand the treatment offered to the local population.

“Now we have a local partner with clear objectives and strong motivation but lacking in experience, training, work tools, supervision, and most of all, long-term legitimacy within the local population,” Abi-Aad explained. “MSF provides all these things, as well as access to patients within the structures where we work. Our support is crucial to both the expansion and development of the program and its sustainability.”

MSF has been present in Libya since February 25 and is providing assistance in the cities of Misrata, Benghazi, Zintan, in camps along the Libyan-Tunisian border, and on the Italian islands of Lampedusa and Sicily. MSF is still trying to access other areas affected by the Libyan conflict, including the city of Tripoli. To ensure the independence of its medical work, MSF relies solely on private financial donations to fund its activities in Libya and does not accept funding from any government, donor agency, nor from any military or politically affiliated group.